Trauma Tx Costs Vary for Same Outcome

Action Points

This study found that there are signiﬁcant regional differences in the inpatient cost of trauma care, with lowest costs in the Northeast.

Point out, however, that the differences in cost did not translate into differences in mortality by region.

The inhospital cost of treating trauma patients is lowest in the Northeast and highest in the West, but without a significant difference in mortality rates across the U.S., researchers reported.

In a retrospective analysis of discharge data, the average cost of treating a trauma patient for one of five types of injuries was $14,022 in the Northeast, according to Adil Haider, MD, of Johns Hopkins University School of Medicine, and colleagues.

But for reasons that remain unclear it was 18% higher in the South, 22% more in the Midwest, and 33% more in the West, Haider and colleagues reported in the Journal of Trauma and Acute Care Surgery.

The researchers found that the pattern was similar for each of the five types of injury chosen as index conditions:

Blunt splenic injury

Liver injury

Tibia fracture

Moderate traumatic brain injury

Pneumothorax/hemothorax

Haider and colleagues cautioned that the data are cross-sectional so it's difficult to establish causal relationships. But the findings open the possibility of reducing healthcare costs if lessons can be learned from the way caregivers in lower-cost regions manage their patients, they argued.

"Spending more doesn't always mean saving more lives," Haider said in a statement. "If doctors in the Northeast do things more economically and with good results, why can't doctors out West do the same thing?"

But it may also be true, Haider said, that higher-cost regions have patients with less pain and fewer disabilities after recovery.

"We really need to drill down and figure out what parts of care improve outcomes and what parts drive up costs without improving any outcomes or aspects of care important to patients," he said.

"If surgeons are fixing tibia fractures in the West in a way that's more expensive but makes patients more comfortable, that would not be a trivial finding," Haider said.

The researchers analyzed cost data derived from the Nationwide Inpatient Sample, a 20% stratified sample of discharges from U.S. community hospitals, for the years 2006, 2007, and 2008.

They computed average costs for each of the five index injuries and for all five combined in Northeastern states, including Connecticut, Massachusetts, New Jersey, New York, and Vermont.

Those costs were compared with costs in several states in the South, including Arkansas, Florida, Louisiana, Maryland, and Texas; the Midwest (Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin to name a few); and the West, such as Arizona, California, Colorado, Hawaii, and Washington.

All told, the database contained usable information on 62,678 patients, including 28,536 in the South, 12,975 in the West, 11,450 in the Midwest, and 9,717 in the Northeast.

The most expensive of the index conditions was liver injury, the researchers found, with an average cost of care in the Northeast reaching $16,213 per patient and 18% more in the South, 22% more in the Midwest, and 35% more in the West.

The least expensive was blunt splenic injury, with a per-patient average of $14,037 in the Northeast, and 18%, 21%, and 28% more in the South, Midwest, and West, respectively.

Analysis of outcomes showed no significant differences in mortality, they reported. In the Midwest, the adjusted odds ratio for overall inhospital mortality was 1.00 (95% CI 0.8 to 1.23, P=0.993). In the South, the aOR was 1.44 (95% CI 0.93 to 1.40, P=0.196), and in the West, it was 0.99 (95% CI 0.81 to 1.22, P=0.969).

Study limitations were that the cost data used in the analysis were approximations and may have been under- or overestimated. Some important contributors to the costs of care, such as prehospital and post-acute care costs as well as indirect costs, were not included.

The study was supported by the NIH and the American College of Surgeons.

The authors reported no conflicts of interest.

Reviewed by Zalman S. Agus, MD Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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